nbme ob/gyn form4 - kennychan

[ArchivalUser]

A 52 yo woman comes to the physician for a routine examination. She has mild hypothyroidism well controlled with levothyroxine. Five years ago, she was diagnosed with stage I breast cancer, she completed tamoxifen therapy 1 year ago and is currently in remission. Menopause occurred 4 years ago. Her mother sustained a femoral fracture in a bicycle collision at age of 55 years. The patients has smoked two cigarettes weekly for 25 years. She is 150 cm (4 ft 11 in) tall and weights 43 kg (95 lb), BMI is 19 kg/m2. Examination shows no thyromegaly. There is a small, well-healed surgical scar over the upper outer quadrant of the left breast. The remainder of the breast and pelvic examinations show no abnormalities. Which of the following historical findings is the greatest risk factor for osteoporotic fracture in this patient?
A) BMI
B) Family history of fracture
C) Levothyroxine therapy
D) Tamoxifen therapy
E) Tobacco use (wrong)

Hi, I really do not know why E is not correct because other choices do not make sense. Could be C. Please give your opinions. Thank You!

[ArchivalUser]

answer is A

[ArchivalUser]

But her BMI is 19 which is pretty normal.

[ArchivalUser]

Does anyone have another opinion? I will appreciate it.

[ArchivalUser]

Right now I got it actually high BMI is a protective factor for osteoporosis. In this case. her BMI is low. Thank You Captan!

[ArchivalUser]

But I still don't understand why smoking is not the greatest risk factor for this case.